Engaging Hospital Management in Improving Microbiology Services

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The major goal of the Fleming Fund is to improve the availability, quantity and quality of AMR data, and promote its sharing and use by supporting development of national surveillance systems. To understand the impact of AMR, there must be an increase in data generation from hospitals, an increase in testing in microbiology laboratories and greater demand for data in local hospitals. Thus, understanding the motivations and drivers of the main laboratory users is critical to success.

Previously, we have discussed how to engage doctors (see here) with laboratory services to improve patient care. In this article, we will look at another vital group: the people responsible for running this hospital itself, looking after budgets and managing the different clinical services. Different countries have different systems and this group might be called managers, supervisors, superintendents etc. In this article we will refer to them as hospital administrators.

Many hospital administrators are deeply invested in controlling hospital acquired infections, controlling outbreaks, decreasing costs, and improving drug stewardship. Better utilisation of microbiology laboratories, and subsequently better use of AMR data, can support administrators to succeed in all these areas. Below are some top tips about how to communicate the importance of laboratories to hospital heads:

1. Highlight how laboratories can help reduce hospital acquired infections (HAIs). HAIs are a major concern and can manifest as surgical site infections, blood stream infections, hospital acquired pneumonias or nosocomial fevers etc. HAIs cost money and can also damage the reputation of a hospital or department. Microbiology laboratories play an integral part in HAI surveillance. For example, surveillance can include monitoring the adverse effects of antimicrobial use including Clostridium difficile diarrhoea. Laboratories can help monitor rates and ascertain causes of various types of HAI and should be used in reducing these infections.
2. Explain how testing can help detect outbreaks. Infection prevention and control is an important area where data from a microbiology laboratory is essential. Infection control teams use microbiological data for: (a) Early detection of outbreaks and help in their management by source tracing and isolation. This could include surveillance for Multidrug resistant organisms e.g. Methicillin Resistant Staphylococcus aureus, Extended spectrum β lactamase producing Gram-negative bacteria. (b)Typing of the organisms responsible for the outbreaks. (c) Environmental surveillance (such as surveillance in operating theatres or intensive care units)
3. Demonstrate that use of laboratory services can decrease costs. Data from the microbiology laboratory can also inform administrators and pharmacy workers on the requirements for various antimicrobials and their use. Data can show which antimicrobial maybe ineffective due to high prevalence of resistance, and which cheaper antimicrobials may be effective. If used optimally, this can help rationalise the procurement of antimicrobials and help hospitals in cost saving.
4. Show how laboratories are critical to antimicrobial stewardship (AMS) programmes. AMS programmes promote and ensure the optimal use of antimicrobial treatment. Microbiology laboratories support stewardship programmes by: (a) Providing guidance to clinicians on the collection of adequate and significant specimens. (b) Helping formulate local guidelines for common infectious syndromes and providing cumulative susceptibility reports to update empirical treatment regimes. (c) Promoting the use of drugs for an appropriate duration based on microbiology reports (d) Adding clinical guidance to microbiological reports for clinicians to easily interpret

Microbiology laboratories are sometimes considered to be an unnecessary cost to hospitals. However, it is clear from the above that they have a vital role to play, not just for the treatment of individual patients, but also in contributing to the safe and cost-effective delivery of all hospital services.